The Trajectory of Physical Activity Following Pulmonary Rehabilitation

Completed

Brief Summary: Pulmonary rehabilitation clearly increases exercise capacity, but its effect on physical activity in the home and community settings is less clear. It may take a longer time for this increase in physical activity to occur. It has been stated in an editorial that it takes 3 months to train the muscles but 6 months to train the brain. The Investigators will first evaluate the change in physical activity following pulmonary rehabilitation using state-of-the-science motion detectors, then Investigators will follow the trajectory of physical activity over the next several months.

Detailed Description: This study will follow physical activity following pulmonary rehabilitation longitudinally over 48 weeks. Investigators will use a state-of-the-art accelerometer, to analyze minutes walking per day as the primary outcome, rather than vector magnitude units (VMU) or estimated steps per day. Investigators will explore potential factors influencing this important outcome, including baseline activity levels, demographic variables, changes in exercise capacity, psychological variables, and self-efficacy scores. Finally, Investigators will evaluate the rate of change (trajectory) in physical activity over approximately six months after pulmonary rehabilitation. There are limited data suggesting it takes time for the translation of increased exercise capacity into increased physical activity to occur.

Recruitment & Eligibility

Inclusion Criteria

Adults (≥ 40 years) with a primary clinical diagnosis of Chronic Obstructive Pulmonary Disease (COPD)
A post-bronchodilator forced expiratory volume in one second(FEV1)/forced vital capacity (FVC) < 0.70 from spirometry performed within the preceding 12 months (no specific FEV1 percent-predicted requirement, although we anticipate the FEV1 will average around 45% of predicted, based on previous studies of pulmonary rehabilitation)
The patient was referred to pulmonary rehabilitation
The patient is clinically-stable: no exacerbation in preceding 4 weeks
Modified Medical Research Council (mMRC) dyspnea rating of at least 2 out of 5.

Exclusion Criteria

Disease severity or co-morbidity that would make the patient be at-risk for participation this study
A significant movement disorder, such as hemiplegia, etc.
Inability to read and comprehend the questionnaires, which will be in English
A history of poor wound healing or chronic skin conditions that might predispose to local problems from wearing the DynaPort. (The DynaPort can be worn outside a thin garment, such as a tee shirt, and is relatively thin, without protruding parts. However, since the device may be worn overnight, and there is a remote risk of pressure problems, this exclusion criterion was added).

Primary Outcome Measures

Name	Time	Method
Minutes/Day at 48 Weeks	48 weeks compared to baseline	Investigators will look at changes in directly-measured physical activity (minutes per day of walking activity from the DynaPort) between the 48 ± 3 week assessment and baseline.
Minutes/Day at 12 Weeks	12 weeks compared to baseline	Investigators will look at changes in directly-measured physical activity (minutes per day of walking activity from the DynaPort) between the 12 ± 3 week assessment and baseline.

Secondary Outcome Measures

Name	Time	Method
Activity-related Energy Expenditure (AEE)(J/Min/kg) at 12 Weeks	12 weeks compared to baseline	Investigators will look at changes in activity-related energy expenditure (from the DynaPort) at 12 weeks compared to baseline
Activity-related Energy Expenditure (AEE)(J/Min/kg) at 48 Weeks	48 weeks compared to baseline	Investigators will look at changes in activity-related energy expenditure (from the DynaPort) at 48 weeks compared to baseline

Locations (4): VA Connecticut Research and Education Foundation
🇺🇸
West Haven, Connecticut, United States
Gaylord Hospital
🇺🇸
Wallingford, Connecticut, United States
Ocean State Research Institute
🇺🇸
Providence, Rhode Island, United States
Saint Francis Hospital and Medical Center
🇺🇸
Hartford, Connecticut, United States